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Predictive factors for tumour response after the neoadjuvant-treatment of rectal adenocarcinoma / Fatores preditivos de resposta tumoral após tratamento neoadjuvante de adenocarcinoma retal
De la Pinta, Carolina; Martín, Margarita; Hervás, Asunción; Perna, Luis Cristian; Fernández-Lizarbe, Eva; López, Fernando; Duque, Víctor Jose; Sancho, Sonsoles.
  • De la Pinta, Carolina; Radiation Oncology Department. Hospital Universitario Ramón y Cajal. Madrid. ES
  • Martín, Margarita; Radiation Oncology Department. Hospital Universitario Ramón y Cajal. Madrid. ES
  • Hervás, Asunción; Radiation Oncology Department. Hospital Universitario Ramón y Cajal. Madrid. ES
  • Perna, Luis Cristian; Radiation Oncology Department. Hospital Universitario Ramón y Cajal. Madrid. ES
  • Fernández-Lizarbe, Eva; Radiation Oncology Department. Hospital Universitario Ramón y Cajal. Madrid. ES
  • López, Fernando; Radiation Oncology Department. Hospital Universitario Ramón y Cajal. Madrid. ES
  • Duque, Víctor Jose; Radiation Oncology Department. Hospital Universitario Ramón y Cajal. Madrid. ES
  • Sancho, Sonsoles; Radiation Oncology Department. Hospital Universitario Ramón y Cajal. Madrid. ES
J. coloproctol. (Rio J., Impr.) ; 40(2): 112-119, Apr.-Jun. 2020. tab, graf
Article in English | LILACS | ID: biblio-1134966
ABSTRACT
ABSTRACT Purpose Standard of care for locally advanced rectal cancer is neoadjuvant chemoradiotherapy followed by surgery. This study identified predictive factors for tumour response in our series. Patients and methods Between January 2005 and December 2018, 292 patients with locally advanced rectal cancer treated by preoperative chemo-radiation before surgery were retrospectively analyzed. The radiation dose was 50.4 Gy with fluoropyrimidine-based chemotherapy regimens. Patients-tumour and treatment-factors were tested for influence on tumour down staging and regression grade using Mandard scoring system on surgical specimens (TRG). Results Median age was 69 years (range 39-87); 33.9% of patients was Stage II and 54.5% Stage IIIB. Tumour down staging occurred in 211 patients (73%), including 63 patients (21.6%) with ypT0 (documented T0 at surgery) and 148 patients (50.7%) with a satisfactory tumour regression grade defined as TRG2­3. Upper rectal tumours were identified to predictive factors for pathologic complete response by univariate analysis (p = 0.002). TRG1­3 was associated with intervals from chemo-radiation to surgery (p = 0.004); TRG1­3 rates were higher with longer intervals 1.71% in ≤ 5 weeks, 23.63% in 6-8 weeks and 46.9% in ≥ 9 weeks; and PTV 50.4 ≥ 800cc (p = 0.06); 3 and 5 years survivals were 85% and 90% for the group as a whole. Among ypT0 cases, the overall survival was 91.1% without significantly different (p = 0.25) compared with the remaining group, 87.2%. Among ypT0 cases, the relapse-free survival was 94.5%, with significantly different (p = 0.03) compared with the remaining group 78.2%. There were no treatment-associated fatalities. Thirty-two patients (10.96%) experienced Grade III/IV toxicities (proctitis, ephitelitis and neutropenia). Conclusions Tumour localization was identified as predictive factors of pathologic complete response for locally advanced rectal cancer treated with preoperative chemo-radiation. Upper rectal tumours are more likely to develop complete responses. Delay in surgery was identified as a favorable predictive factor for TRG1­3. The relapse-free survival in pathologic complete response group was higher compared with non-pathologic complete response.
RESUMO
RESUMO Objetivo O tratamento padrão para o câncer retal localmente avançado é a quimiorradioterapia neoadjuvante, seguida de cirurgia. Este estudo identificou fatores preditivos de resposta tumoral em nossa série. Pacientes e métodos Entre janeiro de 2005 e dezembro de 2018, 292 pacientes com câncer retal localmente avançado, tratados com quimiorradiação pré-operatória, foram retrospectivamente analisados. O tratamento quimioterápico foi à base de fluoropirimidina e a dose de radiação foi de 50,4 Gy. Os tumores dos pacientes e os fatores do tratamento foram testados quanto à influência no estadiamento do tumor e no grau de regressão usando o sistema de classificação de Mandard em espécimes cirúrgicos (TRG). Resultados A mediana das idades foi 69 anos (variação de 39 a 87); 33,9% dos pacientes estavam no estágio II e 54,5% no estágio IIIB. O estadiamento do tumor ocorreu em 211 pacientes (73%), incluindo 63 pacientes (21,6%) com ypT0 (T0 documentado na cirurgia) e 148 pacientes (50,7%) com grau satisfatório de regressão do tumor, definido como TRG1­3. Os tumores retais superiores foram identificados como fatores preditivos de resposta patológica completa por análise univariada p = 0,002. TRG1­3 foi associado aos intervalos entre a quimioterapia e a cirurgia p = 0,004; As taxas de TRG1­3 foram maiores com intervalos mais longos 1,71% em ≤ 5 semanas, 23,63% em 6-8 semanas e 46,9% em ≥ 9 semanas; e PTV 50,4 ≥ 800cc (p = 0,06); as sobrevidas de 3 e 5 anos foram de 85% e 90% para o grupo em geral. Entre os casos de ypT0, a sobrevida global foi de 91,1%, sem diferença significativa (p = 0,25) na comparação com o grupo restante (87,2%). Entre os casos de ypT0, a sobrevida livre de recidiva foi de 94,5%, com diferença significativa (p = 0,03) na comparação com o grupo restante (78,2%). Não houve fatalidades associadas ao tratamento. Trinta e dois pacientes (10,96%) apresentaram toxicidade de grau III/IV (proctite, efitelite e neutropenia). Conclusões A localização do tumor foi identificada como fator preditivo de resposta patológica completa para o câncer retal localmente avançado tratado com quimiorradiação pré-operatória. Os tumores retais superiores têm mais probabilidade de desenvolver respostas completas. O atraso da cirurgia foi identificado como um fator preditivo favorável para o TRG1­3. A sobrevida livre de recidiva no grupo com resposta patológica completa à quimiorradioterapia pré-operatória foi maior comparado ao grupo com resposta patológica incompleta.
Subject(s)


Full text: Available Index: LILACS (Americas) Main subject: Adenocarcinoma / Neoadjuvant Therapy / Chemoradiotherapy, Adjuvant Type of study: Prognostic study / Risk factors Limits: Humans Language: English Journal: J. coloproctol. (Rio J., Impr.) Journal subject: Cirurgia / Doen‡as Retais / Doen‡as do Colo / Gastroenterology / Cirurgia Year: 2020 Type: Article Affiliation country: Spain Institution/Affiliation country: Radiation Oncology Department/ES

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Full text: Available Index: LILACS (Americas) Main subject: Adenocarcinoma / Neoadjuvant Therapy / Chemoradiotherapy, Adjuvant Type of study: Prognostic study / Risk factors Limits: Humans Language: English Journal: J. coloproctol. (Rio J., Impr.) Journal subject: Cirurgia / Doen‡as Retais / Doen‡as do Colo / Gastroenterology / Cirurgia Year: 2020 Type: Article Affiliation country: Spain Institution/Affiliation country: Radiation Oncology Department/ES